NUR 445 Module 5 Capstone Project Proposal Example

Hearing the Plan of Care: A Capstone Project Proposal to Offer Personal Hearing Amplifiers to Older Adults on a Medical Unit

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 445: Nursing Management in Health Care

Instructor Name

Month Day, Year

Hearing the Plan of Care: A Capstone Project Proposal to Offer Personal Hearing Amplifiers to Older Adults on a Medical Unit

Background and Significance

Hearing loss is among the most common chronic conditions in older adults, and hospitals are noisy places where communication depends on hearing. Most older adults with hearing loss do not use hearing aids, and those who do often leave them at home when admitted in an emergency. For a hospitalized patient, not hearing the nurse means missing information about medications, procedures and discharge, and agreeing to things they did not understand.

The consequences reach beyond communication. Shukla et al. (2019) reviewed 13 studies of inpatients and found that hearing loss damaged communication with clinicians in every one. In a retrospective cohort of 52,805 inpatients, self-reported hearing loss was associated with falls, and patients with hearing loss who lacked hearing aids were significantly more likely to fall even after accounting for the Morse Fall Scale (Tiase et al., 2020). Communication failures also threaten informed consent and safe discharge.

Local Problem

On our 30-bed adult medical unit, more than half of patients are 65 or older. During a two-week tally in which nurses noted patients who had difficulty hearing bedside conversation, 23 of 141 older patients were identified, about 16%. Only five had hearing aids with them. Nurses reported raising their voices, which is heard by roommates and compromises privacy, writing notes, or directing information to family members, which bypasses the patient. The unit has no amplifiers and no hearing screening question at admission.

PICOT Question

For hard-of-hearing medical patients aged 65 and over (P), does offering a personal hearing amplifier during nursing teaching, consent and discharge conversations (I), compared with usual communication (C), improve patient-reported understanding of care and discharge instructions (O) during the hospital stay (T)?

Review of the Literature

Five sources form the evidence base. The systematic review by Shukla et al. (2019) established the problem and noted that, among studies testing an intervention, simple low-cost voice amplifiers improved communication. A scoping review of 12 studies on personal hearing amplifiers in clinical settings found consistent improvements in patients' ability to understand providers and high satisfaction, but inconsistent use by staff because of limited awareness and problems with device maintenance and tracking (Koerber et al., 2024). That finding shaped this proposal's emphasis on storage, cleaning and tracking.

The strongest single study is a randomized pilot with 133 veterans aged 60 and older in an emergency department. Those given a personal amplifier reported better understanding; 75% said they understood what was said without effort compared with 56% of controls, and 75% said clinicians explained their presenting problem compared with 36% of controls. Three-day return visits were 3% versus 9% (Chodosh et al., 2021). On acute care units, a feasibility study found that 24 of 25 hard-of-hearing patients were satisfied with an amplified hearing device and nurses reported more efficient communication (Kimball et al., 2018). Finally, the falls study by Tiase et al. (2020) supports amplification as a possible safety measure, though it did not test amplifiers directly.

Together, the evidence is consistent in direction and low in risk, but mostly from small or pilot studies. It supports a unit-level evidence-based practice project rather than a claim that amplifiers will reduce falls or readmissions.

Project Plan

The project is organized with the Iowa Model of Evidence-Based Practice, whose sequence moves from a trigger to a team, then to gathering and judging evidence, and then to a trial on one unit, with adoption decided only after the trial (Iowa Model Collaborative, 2017). The trigger is the problem nurses identified at the bedside. The team will include the nurse manager, the unit educator, two staff nurse champions, a speech-language pathologist and a representative from the patient experience office.

Implementation will take eight weeks. A hearing screening question, "Do you have trouble hearing conversation in a quiet room?", will be added to the admission assessment. Four personal amplifiers with disposable ear covers will be stored in a labeled bin at the nurses' station with a sign-out sheet. Nurses will offer an amplifier to patients who screen positive for teaching, consent and discharge conversations. Staff education will consist of a 10-minute huddle demonstration and a one-page guide on use, cleaning and tracking, informed by the barriers identified in the scoping review.

Evaluation

Outcome measure: two questions asked at discharge of patients who screened positive, asking whether they understood what nurses told them and whether they understood their discharge instructions, on a four-point scale. Process measure: the percentage of screened-positive patients offered an amplifier, drawn from the sign-out sheet and documentation. Balancing measures: devices lost or damaged, and nurses' reported time per teaching conversation. Results from the eight weeks will be compared with discharge responses from screened-positive patients during two weeks before the pilot. Findings will guide the decision to adopt, adapt or stop.

Resources and Budget

Four personal amplifiers, disposable ear covers, batteries and cleaning wipes are estimated to cost under $1,000, which the manager has agreed to request from the unit's supply budget. Staff time is limited to huddle education and documentation. Even a small reduction in falls would offset the cost, since a recent economic evaluation estimated that inpatient falls add about $35,000 to $37,000 in costs per fall (Dykes et al., 2023), though this project will not claim to reduce falls.

Approval and Ethics

The project will be reviewed through the hospital's quality improvement process because it implements existing evidence on one unit and does not seek generalizable knowledge. No identifiable patient information will be collected for evaluation. Patients may decline an amplifier at any time.

Anticipated Barriers

Three barriers are likely, based on the scoping review's findings and the unit's experience. First, staff may forget the devices exist; the screening question at admission and a reminder in the discharge checklist address this. Second, devices may go missing or be stored dirty; a labeled bin, a sign-out sheet and a cleaning step in the guide address this, and the balancing measure tracks losses. Third, some patients may decline because the headphones feel unfamiliar or stigmatizing; nurses will offer the device as a routine option rather than a judgment about the patient's hearing, and decline rates will be recorded. A brief review at week four will allow the team to adjust the plan before the evaluation.

Conclusion

Patients cannot participate in care they cannot hear. Offering personal hearing amplifiers is a low-cost, evidence-supported way to help hard-of-hearing older adults understand their care, and this proposal provides a feasible plan to test it on one unit before the NUR 464 capstone carries it forward.

References

Chodosh, J., Goldfeld, K., Weinstein, B. E., Radcliffe, K., Burlingame, M., Dickson, V., Grudzen, C., Sherman, S., Smilowitz, J., & Blustein, J. (2021). The HEAR-VA pilot study: Hearing assistance provided to older adults in the emergency department. Journal of the American Geriatrics Society, 69(4), 1071-1078. https://doi.org/10.1111/jgs.17037

Dykes, P. C., Curtin-Bowen, M., Lipsitz, S., Franz, C., Adelman, J., Adkison, L., Bogaisky, M., Carroll, D., Carter, E., Herlihy, L., Lindros, M. E., Ryan, V., Scanlan, M., Walsh, M.-A., Wien, M., & Bates, D. W. (2023). Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program. JAMA Health Forum, 4(1), e225125. https://doi.org/10.1001/jamahealthforum.2022.5125

Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Kimball, A. R., Roscigno, C. I., Jenerette, C. M., Hughart, K. M., Jenkins, W. W., & Hsu, W. (2018). Amplified hearing device use in acute care settings for patients with hearing loss: A feasibility study. Geriatric Nursing, 39(3), 279-284. https://doi.org/10.1016/j.gerinurse.2017.10.009

Koerber, R. M., Kokorelias, K. M., & Sinha, S. K. (2024). The clinical use of personal hearing amplifiers in facilitating accessible patient-provider communication: A scoping review. Journal of the American Geriatrics Society, 72(7), 2195-2205. https://doi.org/10.1111/jgs.18784

Shukla, A., Nieman, C. L., Price, C., Harper, M., Lin, F. R., & Reed, N. S. (2019). Impact of hearing loss on patient-provider communication among hospitalized patients: A systematic review. American Journal of Medical Quality, 34(3), 284-292. https://doi.org/10.1177/1062860618798926

Tiase, V. L., Tang, K., Vawdrey, D. K., Raso, R., Adelman, J. S., Yu, S. P., Applebaum, J. R., & Lalwani, A. K. (2020). Impact of hearing loss on patient falls in the inpatient setting. American Journal of Preventive Medicine, 58(6), 839-844. https://doi.org/10.1016/j.amepre.2020.01.019